1554: UTILITY OF REPEAT HEAD CT ON MILD TRAUMATIC BRAIN INJURY PATIENTS

Abstract Background The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). Methods We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. Results One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). Conclusion Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.

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Comparison of Quantitative EEG With Current Clinical Decision Rules for Head CT Utilization in Acute Mild Traumatic Brain Injury in the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.07.356 ◽

2013 ◽

Vol 62 (4) ◽

pp. S27-S28

Author(s):

S.I. Ayaz ◽

C. Thomas ◽

V. Mika ◽

P. Medado ◽

D. Robinson ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Decision Rules ◽

Clinical Decision ◽

Quantitative Eeg ◽

Clinical Decision Rules ◽

Head Ct ◽

Ct Utilization

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Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study

Brain Sciences ◽

10.3390/brainsci10050269 ◽

2020 ◽

Vol 10 (5) ◽

pp. 269

Author(s):

Debbie Madhok ◽

John Yue ◽

Xiaoying Sun ◽

Catherine Suen ◽

Nathan Coss ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Pilot Study ◽

Mild Traumatic Brain Injury ◽

Psychiatric History ◽

Clinical Predictors ◽

Head Ct ◽

Risk Patients

A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.

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Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury

Journal of the American Medical Informatics Association ◽

10.1136/amiajnl-2013-002536 ◽

2014 ◽

Vol 21 (e2) ◽

pp. e347-e351 ◽

Cited By ~ 42

Author(s):

A. Gupta ◽

I. K. Ip ◽

A. S. Raja ◽

J. E. Andruchow ◽

A. Sodickson ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Decision Support ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Clinical Decision Support ◽

Guideline Adherence ◽

Clinical Decision ◽

Head Ct ◽

Emergency Department Patients

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Repeat head CT in mild traumatic brain injury is really necessary?

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2019.10.010 ◽

2020 ◽

Vol 38 (2) ◽

pp. 393-394

Author(s):

Alba Scerrati ◽

Gianluca Trevisi ◽

Pasquale De Bonis ◽

Annunziato Mangiola

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Head Ct

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Limited benefit of systematic head CT for mild traumatic brain injury in patients under antithrombotic therapy

Journal of Neuroradiology ◽

10.1016/j.neurad.2021.02.004 ◽

2021 ◽

Author(s):

Lucie Colas ◽

Sahara Graf ◽

Juliette Ding ◽

Gregory Bertolotti ◽

Nicolas Thellier ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Antithrombotic Therapy ◽

Head Ct

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Persistent postconcussive symptoms in children and adolescents with mild traumatic brain injury receiving initial head computed tomography

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.9.peds20421 ◽

2021 ◽

pp. 1-10

Author(s):

Lennart Riemann ◽

Daphne C. Voormolen ◽

Katrin Rauen ◽

Klaus Zweckberger ◽

Andreas Unterberg ◽

...

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Young Patients ◽

High Energy ◽

Ct Imaging ◽

Head Ct ◽

Postconcussive Symptoms

OBJECTIVEThe aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment.METHODSPatients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13–15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire.RESULTSA total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001).CONCLUSIONSAdolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.

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